Colorado Department of Healthcare Policy and FinancingColorado Department of Healthcare Policy and Financing Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resourcesImproving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources 1 The Medicaid Community Behavioral Health Services Program Comprehensive behavioral health services to Medicaid members in Colorado

Colorado Department of Healthcare Policy and FinancingColorado Department of Healthcare Policy and Financing Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resourcesImproving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources 2 Orange: Access Behavioral Care (ABC) Green: Behavioral Healthcare Inc (BHI) *Pink: Northeast Behavioral Health Partnerships (NBHP) -> June 30 th. *Yellow: Colorado Health Partnerships (CHP) *Blue: Foothills Behavioral Health Partnerships (FBHP) Behavioral Health Organizations (overview) * Value Options

Colorado Department of Healthcare Policy and FinancingColorado Department of Healthcare Policy and Financing Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resourcesImproving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources 3 Behavioral Health Organizations (BHOs) then contract with their own network of behavioral health providers, including individual practitioners and community mental health centers in order to offer services to all those in need. Individual providers Federally Qualified Health Centers Community Mental Health Centers BHO Methadone Clinics Detox facilities Hospitals Specialists

Colorado Department of Healthcare Policy and FinancingColorado Department of Healthcare Policy and Financing Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resourcesImproving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources 4 BHOs have large and varied provider networks Single case agreements

Colorado Department of Healthcare Policy and FinancingColorado Department of Healthcare Policy and Financing Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resourcesImproving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources 5 Access to care standards BHOs are required to complete an intake and initial assessment of any Medicaid client requesting routine services within seven business days of the initial request.

Colorado Department of Healthcare Policy and FinancingColorado Department of Healthcare Policy and Financing Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resourcesImproving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources 6 Placing Medicaid clients on waitlists to be seen for an initial appointment outside of the seven day timeframe is not acceptable. Access to care standards

Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Can anyone receive services? Anyone can be assessed Covered diagnosis Covered procedure Medically necessary 7

Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing A note about medical necessity “Medically Necessary” describes a service that, in a manner in accordance with professionally accepted clinical guidelines and standards of practice in behavioral health care: – Is reasonably necessary for the diagnosis or treatment of a covered mental health disorder or to improve, stabilize or prevent deterioration of functioning resulting from such a disorder; and – Is clinically appropriate in terms of type, frequency, extent, site and duration; – Is furnished in the most appropriate and least restrictive setting where services can be safely provided; and – Cannot be omitted without adversely affecting the Member’s mental health and/or physical health conditions associated with the Member’s covered mental health diagnosis, or the quality of care rendered. 8

Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Behavioral Health In addition to comprehensive mental health services, effective 1/1/2014, BHOs now manage substance use disorder (SUD) services. SUD services were previously offered in Fee- For-Service Medicaid on a limited basis. 9

Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing SUD services available through the BHO program Alcohol and/or drug assessment Detoxification services (includes: physical assessment of detoxification progression including vital signs monitoring; safety assessment; provision of daily living needs including hydration, nutrition, cleanliness and toiletry for clients; Level of motivation assessment for treatment evaluation) Individual and group therapy Targeted case management Drug screening and monitoring Peer advocate services* Medication Assisted Treatment* 10

Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 11 What medications are covered in association with chemical dependency? Methadone* Suboxone (buprenorphine and naloxone) Subutex (buprenorphine) Revia (naltrexone) Vivitrol (naltrexone) Antabuse (disulfiram) * Methadone maintenance is covered by the BHOs. The rest of the medications are medical/pharmacy benefits.

Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 12 What mental health services are available?  Inpatient hospital psychiatric care  Outpatient hospital psychiatric services  Psychiatrist services  Individual and group therapy  Medication management  Case management services  Emergency services  Vocational services  Clubhouse/drop-in centers  Residential services  Assertive Community Treatment  Recovery services  Respite services  Prevention/early intervention activities  School-based and day treatment services for children/youth

Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 13 What else is new for the upcoming contract? Focus on integration Focus on care coordination Department of Corrections Nursing facilities Department of Human Services (child welfare) Program Improvement Advisory Committee (PIAC) Increased requirement of consistent trainings Increased access to care standards 4 services within 45 days Focus on trauma informed care Clarifying language for Brain Injury clients

Colorado Department of Healthcare Policy and FinancingColorado Department of Healthcare Policy and Financing Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resourcesImproving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources 14 If issues arise…… Office of Member and Family Affairs Quality Director →Remember, the BHOs are ultimately responsible for enforcing the standards of care

Colorado Department of Healthcare Policy and FinancingColorado Department of Healthcare Policy and Financing Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resourcesImproving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources %2FHCPFLayout 15 How do I contact the BHO or find a BHO provider? -> Benefits -> Medicaid Managed Care -> Behavioral Health Organizations

Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 16 BHO contact numbers: Access Behavioral Care (ABC) Behavioral Healthcare Inc (BHI) Foothills Behavioral Health Partnerships (FBHP) Colorado Health Partnerships (CHP) (800) Northeast Behavioral Health Partnerships (NBHP) (effective now until June 30, 2014) Access Behavioral Care Northeast (844) (effective July 1, 2014) Helpful resources

Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 17 Questions?

Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Matt Ullrich Contract Performance & Operations Specialist Nikki Lemmon Behavioral Health Specialist